立体放射治疗复发鼻咽癌的初步探讨

Preliminary study of 3D reirradiation for recurrence of nasopharyngeal carcinoma(abstract)

探讨立体放射治疗（立体定向和适形放射治疗）对复发鼻咽癌的疗效和并发症。12例根治性放疗后复发患者，初次放疗至复发的中位间隔时间为10个月（6-48个月）。7例有头痛和（或）颅神经损伤症状；3例经活检病理确诊，9例经CT和（或）MRI诊断。在CT／MRI上肿瘤最大径≥4cm者8例，≤4cm者4例。三维适形放射治疗（3DCRT）5例，照射剂量42Gy（20-60Gy）；分次放射外科治疗7例，其中3例采用多靶点照射技术，4-5Gy／次，隔日或1次／d，总剂量40-48Gy。12例患者中6例死于局部复发和（或）远处转移，3例患者已带瘤生存22、28和34个月，另3例在放疗后肿瘤完全消退，已健康生存12、33和48个月。全组中位生存时间为10个月。有1例患者死于鼻咽大出血。初步研究结果提示，采用三维放疗技术较小靶体积照射，对局限的复发鼻咽癌能达到良好的治疗效果，值得进一步探讨。对于病变广泛的晚期患者则能达到一定姑息减症的效果。

The objective of this research was to study the curative effect of 3D reirradiation for recurrent nasopharyngeal carcinoma. Twelve recurrent nasopharyngeal carcinoma patients were treated with 3D small-volume irradiation technique from May. 1998 to Dec. 2002. The mean interval between initial and re-treatment was 10 months（6-48 monthes）, Of the 12 patients, 7 had headache and/or signs of cranial nerves involvement, 3 patients had pathological evidence of recurrence and 9 were confirmed relapse by CT and/or MRI. On CT/MRI images the maximum dimension of lesion was more than 4 cm in 8 patients, and less than 4 cm in 4 patients. Five patients were treated with 3D conformal radiotherapy, and the mean dose was 42 Gy （20-60 Gy）, Seven patients were treated with fractionated radiosurgery, and of them, 3 were treated with multi-target technique. The total dose was 40-48 Gy and 4-5 Gy per fraction. Results： Of the 12 patients, 6 died from local recurrence and/or distant metastasis, 3 patients lived 22, 28 and 34 months respectively with tumor persistence or recurrence after the retreatment, and another 3 patients lived 12, 33 and 48 months with disease-free after the reirradiation. The median survival time was 10 months. One patient died from hemorrhage of nasopharyngeal cavity and no other sever complications occurred. Conclusions. 3D small-volume reirradiation is an effective method in the treatment of limited recurrent nasopharyngeal carcinoma. Satisfactory local control and survival can chived. For advanced recurrent lesions palliation in some extent can chived without severe complications.